BACKGROUND: Suspected fetal distress usually results in expedited delivery of a baby (often operatively). The potential harm to a mother and baby from operative delivery may not always be justified especially when fetal distress may be misdiagnosed. Even with a correct diagnosis it is not clear whether an operative or conservative approach is better.OBJECTIVES: The objective of this review was to assess the effects of operative management for fetal distress on maternal and perinatal morbidity.SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (15 February 2012).SELECTION CRITERIA: Randomised trials of operative (caesarean section or expedited vaginal delivery) versus conservative management of suspected fetal distress.DATA COLLECTION AND ANALYSIS: Trial quality assessment and data extraction were done by both review authors.MAIN RESULTS: One study of 350 women was included. This trial was carried out in 1959. There was no difference in perinatal mortality (risk ratio 1.18, 95% confidence interval 0.56 to 2.48).AUTHORS' CONCLUSIONS: There have been no contemporary trials of operative versus conservative management of suspected fetal distress. In settings without modern obstetric facilities, a policy of operative delivery in the event of meconium-stained liquor or fetal heart rate changes has not been shown to reduce perinatal mortality.

Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of FortHare, Eastern Cape Department of Health, East London, South Africa. justhof@gmail.com.